Difficult Topics Flashcards
A 52 year old female presents to her GP with a headache and jaw pain. She has also noticed some blurring in her right eye. Over the past few months she has had some pain in her shoulders and back. What is the most definitive investigation?
ESR/CRP Head CT Pathergy Test Temporal Artery Biopsy Lumbar Puncture
Temporal Artery Biopsy
First = ESR, but definitive = biopsy
A 35 year old patient presents to the GP after he noticed some mouth and genital ulcers. When asked about his past medical history, he notes that he came to the GP around 5 years ago due to some blurred vision and pain in the eye. What is the most likely diagnosis?
Kawasaki’s disease Microscopic polyangitis Takayasu’s arteritis Behcet’s disease Polymyalgia rheumatica
Behcet’s disease
Triad = Oral ulcers, Genital ulcers, Uveitis
A 60 year old gentleman presents with recurrent nosebleeds and a persistently runny nose. He has also reported that his urine has been rosy in colour on a few occasions. What is the most likely diagnosis?
Polyarteritis Nodosa Polymyalgia Rheumatica Granulomatosis with Polyangitis Kawasaki Disease Eosinophilic Granulomatosis with Polyangitis
Granulomatosis with Polyangitis
A 38 year old woman has a history of uncontrolled asthma is admitted with shortness of breath. An F1 notices her high eosinophil count and sends another blood test to confirm his diagnosis. Which antibody titre would you expect to be raised?
ANA P-ANCA Anti-ds DNA C-ANCA Ro
P-ANCA
Eosinophilic Granulomatosis with Polyangitis
Main phrases: Polymyalgia Rheumatica
Pain and stiffness in neck/shoulders/arms/hips
Worse in morning or evening
Fever
Parvovirus B19
HLA - DR4
Associated symptoms of temporal arteritis.
Main phrases: Temporal Arteritis
Headache
Scalp tenderness
Jaw claudication
Blurred vision/double vision
Main phrases: Polyarteritis Nodosa
Hep B association
Rosary bead appearance of vessels
Main phrases: Behcets disease
Triad: oral ulcers, genital ulcers and uveitis
A 22 year old student presents to A&E following a collapse whilst waiting for an exam. She has no previous medical history. An ABG is conducted. What does the ABG show?
Uncompensated respiratory alkalosis Metabolic alkalosis with compensation Respiratory acidosis with compensation Uncompensated metabolic acidosis Respiratory alkalosis with compensation
pH: 7.56 (7.35 - 7.45) pO2: 10.7 (10 - 14) pCO2: 3.2 (4.5 – 6) HCO3-: 22 (22 – 26) BE: -2 (-2 - +2)
Uncompensated respiratory alkalosis
A 15 year old boy is bought into A&E by his mother after a severe bought of diarrhoea and vomiting. He has a mild fever, a loss of appetite and a stomach ache. An ABG is performed. What does this ABG show?
Respiratory acidosis with compensation Uncompensated metabolic alkalosis Metabolic alkalosis with compensation Uncompensated respiratory alkalosis Metabolic acidosis with compensation
pH: 7.49 (7.35 - 7.45) pO2: 10.7 (10 - 14) pCO2: 6.8 (4.5 – 6) HCO3-: 30 (22 – 26) BE: +5 (-2 - +2)
Metabolic alkalosis with compensation
A 75 year old man who has recently had an MI comes in to A&E following shortness of breath. He has had trouble sleeping, and upon performing a respiratory exam you note bi-basal crackles. An ABG is performed. What does the ABG show?
Metabolic acidosis with compensation Respiratory alkalosis with compensation Uncompensated respiratory acidosis Respiratory acidosis with compensation None of the above
pH: 7.32 (7.35 - 7.45) pO2: 8.5 (10 - 14) pCO2: 6.6 (4.5 – 6) HCO3-: 24 (22 – 26) BE: +1 (-2 - +2)
Uncompensated respiratory acidosis
A 19 year old girl is brought to A&E for an acute asthma attack. She is tachypnoeic, agitated and there is an obvious wheeze. The paramedics have initiated 7L/min oxygen with salbutamol burst therapy and ipratropium. At AE, she has received further salbutamol and prednisolone. An ABG was performed. What is the most likely cause?
Respiratory acidosis with metabolic compensation
Uncompensated respiratory acidosis
Metabolic acidosis with respiratory compensation
Uncompensated metabolic alkalosis
Metabolic alkalosis with respiratory compensation
pH: 7.32 (7.35 - 7.45) pO2: 11.4 (10 - 14) pCO2: 2.3 (4.5 – 6) HCO3-: 21 (22 – 26) BE: -2 (-2 - +2)
K+ : 3.1 (3.5 – 5)
Na+ : 141 (135 – 145)
Anion Gap: 22
Metabolic acidosis with respiratory compensation
